| National Provider Identifier [NPI]: | 1376722009 |
| Last Name Of The Provider | HOLT |
| First Name Of The Provider | SHEA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 950 W MAGNOLIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761044501 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 13847 |
| Number Of Medicare Beneficiaries | 819 |
| Total Submitted Charge Amount | 1090242 |
| Total Medicare Allowed Amount | 454334.24 |
| Total Medicare Payment Amount | 347493.91 |
| Total Medicare Standardized Payment Amount | 356754.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 10188 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 54359.4 |
| Total Drug Medicare AllowedAmount | 27099.91 |
| Total Drug Medicare PaymentAmount | 20983.78 |
| Total Drug Medicare Standardized Payment Amount | 20983.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 3659 |
| Number Of Medicare Beneficiaries With Medical Services | 819 |
| Total Medical Submitted Charge Amount | 1035882.6 |
| Total Medical Medicare Allowed Amount | 427234.33 |
| Total Medical Medicare Payment Amount | 326510.13 |
| Total Medical Medicare Standardized Payment Amount | 335770.27 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 243 |
| Number Of Beneficiaries Age 65 to 74 | 250 |
| Number Of Beneficiaries Age 75 to 84 | 237 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 412 |
| Number Of Male Beneficiaries | 407 |
| Number Of Non Hispanic White Beneficiaries | 539 |
| Number Of Black or African American Beneficiaries | 165 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 100 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 537 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 282 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 65 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 69 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 4.8144 |